Objectives Many older Australians do not receive timely allied health support to maintain mobility and safety at home. An Australian Royal Commission highlighted the potential for integrating digital health programs into community aged care to improve service access, efficiency and reach. However, technology uptake remains limited. This study aimed to co-create a theory-informed implementation model for digital health solutions in community aged care. Methods A qualitative study, involving semi-structured interviews and focus groups, was conducted with healthcare professionals from three Australian community aged care providers. Using implementation frameworks and co-design, priorities, barriers and facilitators for delivering digital health in community aged care were identified. The Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) matching tool informed selection of implementation strategies. Results Thirty-four healthcare professionals participated. Barriers and facilitators were mapped against the ‘Inner Setting’ and the ‘Individual’ domains of the CFIR 2.0 framework. Six strategies were selected to address identified barriers using the CFIR-ERIC tool: Identify and Prepare Champions, Promote Adaptability, Develop a Formal Implementation Blueprint, Build a Coalition, Conduct Ongoing Training and Develop Educational Materials. These strategies were integrated into a codesigned model, leveraging identified facilitators such as program adaptability and clinician engagement, to support effective implementation of digital health solutions into community aged care. Conclusions This study provides a structured, theory-informed implementation model to support integration of digital falls prevention into community aged care. The model offers practical guidance for embedding digital programs within existing funding, workforce and workflow structures.

BACKGROUND:Gait speed is included in the World Falls Guidelines (WFG) fall risk algorithm, yet its ability to discriminate fallers from non-fallers remains unclear. This individual participant data meta-analysis examined the discriminative ability of the WFG-recommended cut point (<0.8 m/s) and the performance of a higher cut point (<1.0 m/s) for predicting falls in community-dwelling older adults and clinical populations at elevated risk of falls. METHODS:Individual data from 28 studies with a quantitative measure of gait speed and at least three months of prospectively reported falls were analysed using modified Poisson regression and Negative Binomial regression, followed by random-effects meta-analyses. RESULTS:Eight studies involving community-dwelling older adults (n = 3627) and twenty studies involving clinical populations (n = 3981) were included. Walking at < 0.8 m/s was associated with increased risk of falling (Relative Risk: 1.27 (95%CI 1.17 - 1.38)) and fall rate (Incidence Rate Ratio: 1.54 (95%CI 1.34 - 1.77)). Diagnostic accuracy was modest (58%, specificity 77%, sensitivity 35%), with consistent findings across planned subgroup analyses for population, fall history, and sex. Analyses using the < 1.0 m/s cut point produced similar effect sizes and accuracy metrics but identified a larger proportion of fallers in both community-dwelling (30.1% vs. 8.7%) and clinical populations (66.9% vs. 46.0%) compared to the < 0.8 m/s cut point. CONCLUSION:Slower gait speed is associated with an increased risk and rate of falling across both population groups, but discriminative accuracy is low. While the < 0.8 m/s threshold shows consistent associations, a < 1.0 m/s cut point may be more clinically useful in community-dwelling and clinical settings because it identifies more fallers.

The Australian and New Zealand Hip Fracture Registry (ANZHFR) is a bi-national clinical quality registry established to enhance care and outcomes for older adults hospitalised with hip fractures. Since its inception in 2015, the ANZHFR has amassed data on over 120,000 hip fractures from 107 hospitals across Australia and New Zealand. This ongoing data collection adheres to an internationally agreed-upon minimum common dataset and incorporates indicators aligned with the Australian Commission on Safety and Quality in Health Care (ACSQHC) Hip Fracture Clinical Care Standard. These indicators reflect best-practice guidelines for hip fracture care. The registry tracks key processes and outcomes, including care at presentation, preoperative pain management, orthogeriatric involvement, timing of surgery, postoperative mobilisation, prevention of subsequent fractures, hospital discharge transitions, functional outcomes, quality of life at 120 days, and post-injury mortality. This manuscript serves as a foundational reference for all future publications using ANZHFR data, providing detailed insights into its structure, scope, and significance. Researchers and collaborators interested in utilising or contributing to the ANZHFR data are encouraged to contact the team at clinical@anzhfr.org.

BACKGROUND:Delirium affects up to 25% of hospitalised older patients; however, there are no effective pharmacological treatments. Accumulating evidence of brain insulin resistance and altered cerebral glucose metabolism during delirium present a promising therapeutic target. OBJECTIVE:To assess the safety and efficacy of intranasal insulin in the treatment of delirium. DESIGN:Single-centre, randomised, double-blind, placebo-controlled trial. SETTING:Two geriatric medicine wards in a tertiary hospital. PARTICIPANTS:100 patients aged over 64 years presenting to hospital and admitted under geriatric medicine with delirium. INTERVENTIONS:Participants were randomised in a 1:1 ratio to receive 20 IU of long-acting insulin or placebo intranasally twice daily until delirium resolution, hospital discharge or intervention futility defined by prespecified criteria. MAIN OUTCOME:The primary outcome was delirium duration, assessed daily using the Confusion Assessment Method. Secondary outcomes included acute length of stay (LOS), delirium severity, antipsychotic use, hospital complications and mortality. RESULTS:The intention-to-treat analysis included 97 participants [intranasal insulin n = 48, control n = 49; mean (SD) age, 87.6 (7.0) years; 63% female]. Baseline characteristics were similar between groups. Median delirium duration [days (IQR)] was 4.8 [2.9, 9.2] for intranasal insulin and 6.8 [4.0, 9.8] for the control (HR 0.7, 95% CI 0.43-1.15; P = .16). Median acute LOS (days) was 7.9 [4.6, 14.5] for intranasal insulin and 12.9 [6.9, 16.8] for the control (HR 0.56, 0.35-0.89; P = .014). No significant differences were observed in other secondary outcomes. Intranasal insulin demonstrated favourable tolerability. Overall, 86% of the participants were compliant with the intervention (≥80% of doses). Prespecified subgroup analysis revealed an age-related response, with participants aged ≤88 years showing shorter delirium duration with intranasal insulin [n = 46; intranasal insulin: median 3.9 (IQR 2.9, 6.9) days vs control: 7.0 (4.7, 9.7); HR 0.34, 0.16-0.74; P = .006], whereas no difference was observed in participants aged >88 years [n = 51; intranasal insulin 5.4 (2.9, 11.1) vs control 4.9 (2.6, 12.9); HR 0.87, 0.39-1.94; P = .73]. CONCLUSION AND RELEVANCE:This is the first study of intranasal insulin for delirium treatment. The reduced LOS combined with the observed age-related effects warrants further investigation into the clinical potential of intranasal insulin in managing delirium in older patients. TRIAL REGISTRATION:ACTRN 12618000318280.

Background: Promoting physical activity among people living with dementia is critical to maximise physical, cognitive and social benefits; yet the lack of knowledge, skills and confidence among health professionals, informal care partners and people with dementia deters participation. As the initial phase of a larger feasibility study, co-design was employed to develop a new model of community care, ‘Changing the Focus’, to facilitate the physical activity participation of older people living with mild dementia. Methods: Co-design methodology was utilised with nine stakeholders (with experience in referring to or providing physical activity programs and/or contributing to policy and program planning) over three workshops plus individual interviews with four care partners of people with dementia. Insights were gathered on the physical activity for people with mild dementia, referral pathways were explored and ‘personas’ were developed and refined. Materials and resources to support exercise providers and referrers to work effectively with people with mild dementia were finalised. Results: Three ‘personas’ emerged from the co-design sessions, aligned with stages of behaviour change: (1) hesitant to engage; (2) preparing to engage; and (3) actively engaged. Referral pathway discussions identified challenges related to limited resources, limited knowledge, access constraints and individual factors. Opportunities were classified as using champions, streamlining processes, recognising triggers for disengagement, influencing beliefs and attitudes, and means of communication. Conclusion: This study captured the views of physical activity referrers and providers and informal care partners in an inclusive and iterative manner. The use of co-design ensured a robust approach to facilitating participation in formal and informal physical activity options for people living with mild dementia. This study has provided the necessary framework from which to develop and test training and resources for the next stage of intervention (a feasibility trial) to improve physical activity participation for people with dementia.

Clinical quality registries indicate that adherence to clinical practice guidelines for the management of hip fracture patients is often not as recommended. The aim of this systematic review is to evaluate interventions that improve adherence to hip fracture guideline recommendations for time to surgery and early mobilization. A systematic review and meta-analysis of English language studies published between 1st January 2000 and 12th March 2025, available from Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science was conducted. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Studies were included if they reported on interventions designed to improve time to surgery or early mobilization in the acute care period for patients aged 50 years and older admitted to hospital with a proximal femoral fracture. Ten studies met inclusion criteria. Interventions to improve time to surgery and early mobilization included care pathways (n = 5), orthogeriatric models of care (n = 2), audit and feedback (n = 1), clinical supervision (n = 1), and pay for performance (n = 1). Interventions were associated with an overall small to moderate positive effect on time to surgery (n = 6, SMD 0.47, 95

OBJECTIVE:To determine if wrist-worn sensor parameters can predict incident dementia in individuals aged 60 + years and to compare prediction with other tools. DESIGN:Observational cohort study. SETTING:Community PARTICIPANTS: The cohort comprised 47,371 participants without dementia, aged 60 + years, who participated in the UK Biobank study (mean age=67 ± 4 years; 52 % female). MEASUREMENTS:Nineteen digital biomarkers were extracted from up-to-7-day wrist-worn sensor accelerometry data at baseline. Univariable and multivariable Cox proportional hazard models examined associations between sensor parameters and prospectively diagnosed dementia. RESULTS:Median follow-up was 7.5 years (interquartile range: 7.0 to 9.0 years), during this time 387 participants (0.8 %) were diagnosed with dementia. Among the gait parameters, slower maximal walking speed had the strongest association with incident dementia (32 % decrease in hazard for each standard deviation increase) followed by lower daily step counts (30 % decrease) and increased step-time variability (17 % increase). While adjusting for age and sex, running duration, maximal walking speed and early bedtime were identified as independent and significant predictors of dementia. The multivariable prediction model performed comparably to the ANU-ADRI and UKB-Dementia Risk Score models in the UK Biobank cohort. CONCLUSIONS:The study findings indicate that remotely acquired parameters from wrist-worn sensors can predict incident dementia. Since wrist-worn sensors are highly acceptable for long-term use, wrist-worn sensor parameters have the potential to be incorporated into dementia screening programs.

OBJECTIVES:To assess the effectiveness and implementation of a telephysiotherapy program for improving mobility, mobility goal attainment, and quality of life of people receiving at-home or residential aged care. STUDY DESIGN:Hybrid type 1 effectiveness-implementation randomised controlled trial. SETTING, PARTICIPANTS:People aged 65 years or older who were receiving community or residential aged care services in Australia, 1 September 2021 - 30 November 2023. INTERVENTION:Telephysiotherapy for Older People (TOP-UP): six-month program of ten telephysiotherapy (Zoom) sessions for assessment and tailored exercise prescription, supported by trained aged care workers and exercise videos. MAIN OUTCOME MEASURES:Primary outcome: mobility (Short Physical Performance Battery [SPPB] score at baseline and six months). SECONDARY OUTCOMES:fall rate (per person), proportion of people with falls, SPPB components (sit-to-stand performance, balance, gait speed), pain (visual analogue scale), mobility goal attainment, physical activity (Incidental and Planned Exercise Questionnaire), quality of life (EQ-5D-5L visual analogue scale). RESULTS:A total of 1348 people were screened at 27 sites, and 242 eligible people were recruited for the trial (mean age, 83 years [standard deviation, 8 years]; 158 women [65%]); 92 of 120 intervention group participants and 100 of 122 control group participants completed the six-month. After adjusting for baseline mobility scores, the mean difference in mobility score at six months (intervention v control group) was 2.1 (95% confidence interval [CI], 1.4-2.7) points. Sit-to-stand performance was more likely to improve in intervention than control participants (adjusted odds ratio, 2.7; 95% CI, 1.3-4.3); intervention participants reported greater quality of life (EQ-5D-5L visual analogue scale: adjusted mean difference, 6.2 [95% CI, 1.8-10.7] points) and less pain (visual analogue scale: adjusted mean difference, -1.1 [95% CI, -1.8 to -0.3] points), and a smaller proportion experienced falls (29, 32% v 44, 44%; risk ratio, 0.62; 95% CI, 0.42-0.92). Of 1348 screened people, 242 enrolled in the trial (18.0%), of whom 186 (77%) completed the trial, and 62 of 66 surveyed participants (94%) endorsed the intervention. No serious adverse events were recorded. CONCLUSION:The TOP-UP program safely improved mobility, reduced fall risk and pain, and improved quality of life for people receiving aged care. Telephysiotherapy could be incorporated into aged care to improve the lives of older Australians. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry, ACTRN 12621000734864 (prospective).

BACKGROUND:Co-creation methods ensure that interventions are tailored to the target group by incorporating their unique insights and preferences, strengthen innovation, and facilitate implementation. Although co-creation research is becoming more common, most research exploring co-creation focuses on the researchers' perspectives rather than the experiences of the target population. By exploring these experiences, researchers can better understand the preferences for, and facilitators/barriers to, engagement and participation to inform future co-creation studies. This study aimed to explore older persons' experiences and insights into participating in co-creation of an intervention to prevent falls. METHODS:Qualitative interviews were conducted with 13 community-dwelling older persons (aged 66-83 years) after their participation in a co-creation study developing an intervention for fall prevention. Data were analyzed using qualitative content analysis. RESULTS:Three themes emerged from the analysis: Diversity of co-creators enriches understanding and creativity, Interactive activities promote learning, and Supportive environments enhance collaboration. These themes describe how participating in workshops with others deepened and broadened participants' knowledge and understanding of the subject and enabled them to contribute their experiences and perspectives. Discussing and testing exercises gave participants new insights into their physical abilities and the importance of exercise and a better understanding of the concept of motor-cognitive exercises and their role in everyday life. A respectful atmosphere where everyone shared responsibility for creating a supportive environment so all participants could express their thoughts was perceived as important by the participants. CONCLUSIONS:The results underscore the potential for co-creation to enhance participants' knowledge and understanding of the topic, as well as their own capacity. For researchers, it is important to consider how to foster an inclusive and supportive environment, thereby boosting participation, engagement and collaboration.

Background StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK.Methods Two hundred and forty-six participants (Australia, n = 184; UK, n = 62) were recruited and encouraged to use StandingTall for 2 h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome.Results The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants' mean age was 73 +/- 7 years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n = 44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred >= 5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 +/- 39% of the prescribed dose (i.e. 39 +/- 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources.Conclusions StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available.Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.

OBJECTIVES:The purpose of this assessor-blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild-to-moderate dementia.METHODS:The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6-month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370).RESULTS:Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6- or 12-months (between-group differences [95% CI] for primary outcomes at 6-months: Forward Digit Span -0.3 [-0.8, 0.3]; TMT-A 2.7 s [-14.1, 19.5]; TMT-B -17.1 s [-79.3, 45.2]). At the 12-month follow-up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver-rated participant quality of life and higher caregiver quality of life compared to control.CONCLUSIONS:This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild-moderate dementia.

Background: Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. Objective: We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Methods: Participants ( n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). Results: The anxious (IRR = 1.70, 95% CI = 1.02–2.84), unaware (IRR = 2.00, 95% CI = 1.22–3.26), and aware (IRR = 2.53, 95% CI = 1.67–3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Conclusions: Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.

OBJECTIVE:The aim of this study was to examine temporal trends (2016-2020) in hip fracture care in Australian and New Zealand (ANZ) hospitals that started providing patient-level data to the ANZ Hip Fracture Registry (ANZHFR) on/before 1 January 2016 (early contributors).METHODS:Retrospective cohort study of early contributor hospitals (n = 24) to the ANZHFR. The study cohort included patients aged ≥50 years admitted with a low trauma hip fracture between 1 January 2016 and 31 December 2020 (n = 26,937). Annual performance against 11 quality indicators and 30- and 365-day mortality were examined.RESULTS:Compared to 2016/2017, year-on-year improvements were demonstrated for preoperative cognitive assessment (2020: OR 3.57, 95% confidence interval [95% CI] 3.29-3.87) and nerve block use prior to surgery (2020: OR 4.62, 95% CI 4.17-5.11). Less consistent improvements over time from 2016/2017 were demonstrated for emergency department (ED) stay of <4 h (2017; 2020), pain assessment ≤30 min of ED presentation (2020), surgery ≤48 h (2020) and bone protection medication prescribed on discharge (2017-2020; 2020 OR 2.22, 95% CI 2.03-2.42). The odds of sustaining a hospital-acquired pressure injury increased in 2019-2020 compared to 2016. The odds of receiving an orthogeriatric model of care and being offered the opportunity to mobilise on Day 1 following surgery fluctuated. There was a reduction in 365-day mortality in 2020 compared to 2016 (OR 0.86, 95% CI 0.74-0.98), whereas 30-day mortality did not change.CONCLUSIONS:Several quality indicators improved over time in early contributor hospitals. Indicators that did not improve may be targets for future care improvement activities, including considering incentivised hip fracture care, which has previously been shown to improve care/outcomes. COVID-19 and reporting practices may have impacted the study findings.

ObjectivesTo determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator.Study designRetrospective population-based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data.Setting, participantsPeople aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 - 31 December 2018.Main outcome measuresThirty-day (primary outcome), 120-day, and 365-day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator.ResultsRegistry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015-2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre-admission walking ability, and residential status, 30-day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30-0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46-0.82) than for low indicator adherence hip fractures, as was 365-day mortality (high adherence: aRR, 0.59 [95% CI, 0.51-0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63-0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61-0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67-0.83) were associated with lower mortality risk at each time point.ConclusionsClinical care for two-thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care.

Purpose: This systematic review aimed to update fragility hip fracture incidences in the Asia Pacific, and compare rates between countries/regions. Method: A systematic search was conducted in four electronic databases. Studies reporting data between 2010 and 2023 on the geographical incidences of hip fractures in individuals aged >= 50 were included. Exclusion criteria were studies reporting solely on high-trauma, atypical, or periprosthetic fractures. We calculated the crude incidence, age- and sex-standardised incidence, and the female-to-male ratio. The systematic review was registered with PROSPERO (CRD42020162518). Results: Thirty-eight studies were included across nine countries/regions (out of 41 countries/regions). The crude hip fracture incidence ranged from 89 to 341 per 100,000 people aged >= 50, with the highest observed in Australia, Taiwan, and Japan. Age- and sex-standardised rates ranged between 90 and 318 per 100,000 population and were highest in Korea and Japan. Temporal decreases in standardised rates were observed in Korea, China, and Japan. The female-to-male ratio was highest in Japan and lowest in China. Conclusion: Fragility hip fracture incidence varied substantially within the Asia-Pacific region. This observation may reflect actual incidence differences or stem from varying research methods and healthcare recording systems. Future research should use consistent measurement approaches to enhance international comparisons and service planning.

This study aims to address and improve the low physical activity levels among people with mild dementia by implementing a novel shared decision-making and motivational support program, named "Changing the Focus". It will utilise a pre-post mixed methods approach, aiming to recruit 60 community living older people with mild dementia and their care-partners. The shared decision-making process will involve the person living with dementia, their care-partner, and a research therapist, using a purpose-designed discussion tool including factors such as preferred physical activities, health status, local opportunities and program accessibility. This process aims to identify personalised local physical activity opportunities. Participants will be supported with the help of a research therapist to engage in targeted community-based physical activities for 12-months, to progress towards the recommended physical activity guidelines of 150 minutes per week. The intervention provided by the research therapist will include three home visits (baseline, 6- and 12-months) and seven motivational support phone calls (within the first six months). Research therapists may provide additional home visits and support calls as needed. Primary outcomes include program participation (participants living with dementia continuing with the program after 12-months), total physical activity time per week (measured using the Active Australia Survey at baseline, 6- and 12- months) and program acceptability (assessed through semi-structured interviews with participants, care-partners, referrers, and physical activity providers). Secondary outcomes include physical performance, mental health, wellbeing measures, and impact on care-partners (evaluated through physical tests or validated scales at baseline, 6- and 12-months). Other implementation aspects include reach, maintenance, safety (falls, other adverse events) and an economic evaluation. Results will inform feasibility, potential benefits, and challenges associated with this innovative shared decision-making and supported physical activity program for people living with mild dementia. Findings will guide future large-scale studies and contribute to enhancing physical activity opportunities for this population.

To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture. A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders. Of 437 patients, 62

BACKGROUND:People with dementia have poorer outcomes after hip fracture and this may be due in part to variation in care. We aimed to compare care and outcomes for people with and without cognitive impairment after hip fracture. METHODS:Retrospective cohort study using Australian and New Zealand Hip Fracture Registry data for people ≥50 years of age who underwent hip fracture surgery (n = 49,063). Cognitive impairment or known dementia and cognitively healthy groups were defined using preadmission cognitive status. Descriptive statistics and multivariable mixed effects models were used to compare groups. RESULTS:In general, cognitively impaired people had worse care and outcomes compared to cognitively healthy older people. A lower proportion of the cognitively impaired group had timely pain assessment (≤30 min of presentation: 61% vs 68%; p < 0.0001), were given the opportunity to mobilise (89% vs 93%; p < 0.0001) and achieved day-1 mobility (34% vs 58%; p < 0.0001) than the cognitively healthy group. A higher proportion of the cognitively impaired group had delayed pain management (>30 mins of presentation: 26% vs 20%; p < 0.0001), were malnourished (27% vs 15%; p < 0.0001), had delirium (44% vs 13%; p < 0.0001) and developed a new pressure injury (4% vs 3%; p < 0.0001) than the cognitively healthy group. Fewer of the cognitively impaired group received rehabilitation (35% vs 64%; p < 0.0001), particularly patients from RACFs (16% vs 39%; p < 0.0001) and were prescribed bone protection medication on discharge (24% vs 27%; p < 0.0001). Significantly more of the cognitively impaired group had a new transfer to residential care (46% vs 11% from private residence; p < 0.0001) and died at 30-days (7% vs 3% from private residence; 15% vs 10% from RACF; both p < 0.0001). In multivariable models adjusting for covariates with facility as the random effect, the cognitively impaired group had a greater odds of being malnourished, not achieving day-1 walking, having delirium in the week after surgery, dying within 30 days, and in those from private residences, having a new transfer to a residential care facility than the cognitively healthy group. CONCLUSIONS:We have identified several aspects of care that could be improved for patients with cognitive impairment - management of pain, mobility, nutrition and bone health, as well as delirium assessment, prevention and management strategies and access to rehabilitation. Further research is needed to determine whether improvements in care will reduce hospital complications and improve outcomes for people with dementia after hip fracture.

Objective What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers? Design A three-round modified e-Delphi study. Participants Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field. Methods A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus. Results Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 52 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n=36; 2) Assessment, n=39; 3) Management, interventions and prevention n=40; 4) Communication, therapeutic relationship and person-centred care, n=17; and 5) Physiotherapists self-management and improvement, n=5. Conclusions This e-Delphi outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians. Contribution of the paper •This e-Delphi study has developed, through expert consensus, the first comprehensive physiotherapy specific core capability framework for providing high-quality care to people with dementia and their families/caregivers.•The core capability framework can be used by physiotherapists to identify knowledge and/or skill gaps, and by physiotherapy educators to assist with entry-level and post-graduate curriculum development and student/workforce training.As physiotherapists play a vital role in working with people with dementia and their caregivers/families, and competencies lie at the heart of effective quality care and service delivery, the newly developed core capability framework serves as basis for broader consultation and input.

ABSTRACT Objectives: We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI). Design: Prospective cohort study with assessments every 2 years (for up to 6 years). Setting: Community, Sydney, Australia. Participants: Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments ( n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) ( n = 157), and those who were cognitively normal at baseline and all reassessments ( n = 232). Measurements: Cognitive and physical function measured over 2–6 years follow-up. Falls in the year following participants’ final assessment. Results: In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample. Conclusions: Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.